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General NPI Number Information
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NPI Number | 1679346621
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Entity Type | Organization
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Legal Business Name | BLOOM COLORADO LLC
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Dates
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Enumeration Date | 11/01/2023
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 7130 N ACADEMY BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3185
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Country | US
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Telephone | 719-762-1510
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Fax | 719-762-1520
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Provider Business Mailing Address
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Address Line | PO BOX 5943
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City | VIRGINIA BEACH
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State | VA
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Zip | 23471-0943
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SANDEEP PANDITTA
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Credential |
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Telephone | 719-762-1510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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